When Culture Matters: Using Compliments and Complaints to Define and Influence Chinese Patients' Satisfaction.

Despite patients' cultural background influencing their satisfaction with medical care the majority of studies draw on assumptions and models from the Western world. We move attention to the East Asian world by investigating the attributes of Chinese patients' satisfaction with their hospital in-patient care. Our research design is an exploratory qualitative study of 577 incidents of Chinese hospital in-patients' complaints and compliments. The data were drawn from a sample of reports of patients' satisfaction with their care in a district general hospital over a five-year period. Analysis focused on satisfactory and dissatisfactory events to derive attributes involved. We find patients in Chinese culture evaluate satisfaction with their care using eight attributes: professionalism, efficiency, chin-chièh, respect, patience, responsibility, value and ethics. We explore how Chinese patients' values and beliefs toward medicine and care-giving construct distinct meanings around these attributes. By synthesizing our findings with those in the literature we propose generic attributes which can form the basis of measures of Chinese patient satisfaction and inform training in cultural competence.

Patient safety in Work Environments: Perceptions of Pediatric Healthcare Providers in Taiwan.

BACKGROUND: Extensive research on the link between the organizational characteristics of the work environment and patient safety in a healthcare organization has been conducted; yet, only a few studies have concentrated on care providers in a pediatric unit. OBJECTIVES: To determine the correlation between different work environment factors impacting patient safety in a pediatric care unit from the perspective of registered nurses working in these units. DESIGN: Cross-sectional design. DATA SOURCES AND METHODS: The study was conducted with 155 registered nurses from a pediatric unit in a medical center in Taiwan with the Chinese version of the Safety Attitudes Questionnaire (SAQ) 2014-2017. RESULTS: Teamwork climate, higher job satisfaction, and better working conditions are linked to positive perceptions of patient safety culture. Emotional exhaustion is negatively related to most dimensions of patient safety. CONCLUSION: Teamwork climate, job satisfaction, working conditions, and emotional exhaustion were identified as critical factors impacting the patient safety climate. IMPLICATIONS FOR NURSING OR HEALTH POLICY: Investments to improve teamwork climate, job satisfaction, and working conditions and reduce emotional exhaustion may have a positive effect on patient safety in pediatric care units.

The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan.

AIMS: In order to pursue a better patient safety culture and provide a superior medical service for patients, this study aims to respectively investigate the perceptions of patient safety from the viewpoints of physicians and nurses in Taiwan. BACKGROUND: Little knowledge has clearly identified the difference of perceptions between physicians and nurses in patient safety culture. Understanding physicians and nurses' attitudes toward patient safety is a critical issue for healthcare organizations to improve medical quality. METHODS: Confirmatory factor analysis (CFA) is used to verify the structure of data (e.g. reliability and validity), and Pearson's correlation analysis is conducted to demonstrate the relationships among seven patient safety culture dimensions. RESULTS: Research results illustrate that more teamwork is exhibited among team members, the more safety of a patient is committed. Perceptions of management and emotional exhaustion are important components that contribute to a better patient safety. More importantly, working conditions and stress recognition are found to be negatively related from the perceptions of nurses. Compared to physicians, nurses reported higher stress and challenges which result from multi-task working conditions in the hospital. CONCLUSIONS: This study focused on the contribution of a better patient safety culture from different viewpoints of physicians and nurses for healthcare organizations in Taiwan. A different attitudes toward patient safety is found between physicians and nurses. The results enable the hospital management to realize and design appropriate implications for hospital staffs to establish a better patient safety culture.

Association of single-nucleotide polymorphisms of high-mobility group box 1 with susceptibility and clinicopathological characteristics of uterine cervical neoplasia in Taiwanese women.

To date, no study associated the genetic polymorphisms of high-mobility group box 1 protein (HMGB1) with the development of uterine cervical cancer. We therefore conducted this study to investigate the associations of HMGB1 single-nucleotide polymorphisms (SNPs) with cervical carcinogenesis and clinicopathological characteristics of cancer patients. Five hundred two women, including 112 with invasive cancer, 85 with precancerous lesions of the uterine cervix, and 305 normal controls, were consecutively enrolled into this study. Analysis of HMGB1 SNPs was done by real-time polymerase chain reaction and genotyping. Our results found that the risk of susceptibility to cervical invasive cancer was 1.85 (95 % CI 1.12-3.04; p = 0.016) in women with TC and 1.99 (95 % CI 1.24-3.23; p = 0.005) in women with TC/CC after adjusting for age, using TT as a comparison reference in HMGB1 SNP rs1412125. In rs2249825, the increased risk was also seen for the development of cervical invasive cancer in women with CG [adjusted odds ratio (AOR) 2.04, 95 % CI 1.22-3.40; p = 0.006] or CG/GG (AOR 2.02, 95 % CI 1.22-3.32; p = 0.006) using CC as a comparison reference. An additional integrated in silico analysis confirmed that rs2249825 creates a binding site for v-Myb, which may affect HMGB1 expression. In conclusion, Taiwanese women with TC or TC/CC in HMGB1 SNP rs1412125 as well as CG or CG/GG in rs2249825 were susceptible to the development of cervical invasive cancer.

Cloud Image Data Center for Healthcare Network in Taiwan.

This paper investigates how a healthcare network in Taiwan uses a practical cloud image data center (CIDC) to communicate with its constituent hospital branches. A case study approach was used. The study was carried out in the central region of Taiwan, with four hospitals belonging to the Veterans Hospital healthcare network. The CIDC provides synchronous and asynchronous consultation among these branches. It provides storage, platforms, and services on demand to the hospitals. Any branch-client can pull up the patient's medical images from any hospital off this cloud. Patients can be examined at the branches, and the images and reports can be further evaluated by physicians in the main Taichung Veterans General Hospital (TVGH) to enhance the usage and efficiency of equipment in the various branches, thereby shortening the waiting time of patients. The performance of the CIDC over 5 years shows: (1) the total number of cross-hospital images accessed with CDC in the branches was 132,712; and (2) TVGH assisted the branches in keying in image reports using the CIDC 4,424 times; and (3) Implementation of the system has improved management, efficiency, speed and quality of care. Therefore, the results lead to the recommendation of continuing and expanding the cloud computing architecture to improve information sharing among branches in the healthcare network.

Applying importance-performance analysis to patient safety culture.

PURPOSE: The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. DESIGN/METHODOLOGY/APPROACH: The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. FINDINGS: The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. ORIGINALITY/VALUE: Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

Single nucleotide polymorphisms at the PRR3, ABCF1, and GNL1 genes in the HLA class I region are associated with Graves' ophthalmopathy in a gender-dependent manner.

OBJECTIVE: To investigate whether a conserved HLA class I region influenced the development of Graves' ophthalmopathy (GO) in patients with Graves' disease (GD) in a Taiwan-Chinese population. DESIGN: Case-control study. PARTICIPANTS: Four hundred sixty-eight Taiwan-Chinese patients with GD; 200 of these patients had GO, whereas 268 patients did not. METHODS: Five single nucleotide polymorphisms (SNPs) between the HLA-A and HLA-C loci were genotyped. MAIN OUTCOME MEASURES: The Mann-Whitney U test and chi-square test with Bonferroni correction were used. The odds ratios (ORs) were estimated by applying unconditional logistic regression with a 95% confidence intervals (CIs). RESULTS: Strong gender effects on the distribution of the SNPs were apparent: male GD patients carrying an A allele at rs2074503 in the PRR3 gene tended to avoid demonstrating GO (P = 0.008; OR, 0.450; 95% CI, 0.248-0.819), whereas female patients tended to show GO (P = 0.01; OR, 1.486; 95% CI, 1.098-2.012). In addition, only the female GD patients with a T allele at rs1264439 in the ABCF-1 gene tended to demonstrate GO (P = 0.005; OR, 1.539; 95% CI, 1.139-2.081). Analysis of the haplotype blocks of the SNPs rs2074505 (GNL1) and rs2074503 (PRR3) showed that haplotype HA1 was underrepresented in male GO patients (P = 0.004; OR, 0.418; 95% CI, 0.228-0.767), whereas HA-4 was underrepresented in female GO patients (P = 0.007; OR, 0.660; 95% CI, 0.490-0.895). CONCLUSIONS: The results suggested that SNPs at PRR3 and ABCF1 genes and the haplotype composed by SNPs at GNL1 and PRR3 between the HLA-A and HLA-C genes tended to predict GO in a gender-dependent manner in patients with GD in Taiwan.

Comparison of various formulae for estimating low-density lipoprotein cholesterol by a combination of ages and genders in Taiwanese adults.

BACKGROUND: The accuracy and precision of the Friedewald formula for estimating low-density lipoprotein cholesterol (LDL-C) is questionable. Although other formulae have been developed, only a few studies compare them. Thus, we compared the efficiencies of various formulae, based on the age and gender of adults, to determine which ones yield more accurate estimations in terms of mean squared error, and which formulae underestimated and overestimated LDL-C performance. METHODS: This study compares various formulae in terms of mean squared error (MSE), as well as underestimation and overestimation of LDL-C concentrations, using subjects of various ages and both genders. Six groups were examined in this study based on age and gender: males 20-44 years old, 45-64, and 65 and above, and females in the same three age ranges. RESULTS: The results show that the Friedewald formula has relatively low accuracy, and while its performance among older (aged 45 and above) women with triglyceride concentrations ≤ 400 mg/dL is better than that with other groups, it is still more inaccurate than the other formulae. In terms of prediction errors and mean squared errors, Tsai's formula (TF) and a calibrated TF provide the most accurate results with regard to the LDL-C concentration. Moreover, based on a cross-validation of age and gender, these two formulae provide highly accurate results for the LDL-C concentrations of all the studied groups, except for women aged 20-44 years. CONCLUSIONS: Based on the experimental results, this study provides a set of benchmarks for the formulae used in LDL-C tests when considering the factors of age and gender. Therefore, it is a valuable method for providing formula benchmarking.

Analyzing patients' values by applying cluster analysis and LRFM model in a pediatric dental clinic in Taiwan.

This study combines cluster analysis and LRFM (length, recency, frequency, and monetary) model in a pediatric dental clinic in Taiwan to analyze patients' values. A two-stage approach by self-organizing maps and K-means method is applied to segment 1,462 patients into twelve clusters. The average values of L, R, and F excluding monetary covered by national health insurance program are computed for each cluster. In addition, customer value matrix is used to analyze customer values of twelve clusters in terms of frequency and monetary. Customer relationship matrix considering length and recency is also applied to classify different types of customers from these twelve clusters. The results show that three clusters can be classified into loyal patients with L, R, and F values greater than the respective average L, R, and F values, while three clusters can be viewed as lost patients without any variable above the average values of L, R, and F. When different types of patients are identified, marketing strategies can be designed to meet different patients' needs.

The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors.

Purpose: This research aims to investigate the role of management leadership in promoting a culture of patient safety within healthcare organizations. Through a comprehensive mediation analysis of the Chinese version of the safety attitudes questionnaire (CSAQ) and patient safety culture, the study examines the interplay between these critical factors and their combined influence on healthcare outcomes. Patients and Methods: In a medical center located in Taiwan, a cross-sectional survey was carried out utilizing the CSAQ. Among the 1500 distributed surveys, 1037 were returned and deemed valid, resulting in a return rate of 69.13%. To investigate the main measures, Structural Equation Modeling with mediation analysis was employed to scrutinize the direct and indirect effects of factors including teamwork climate, job satisfaction, stress recognition, perceptions of management, working conditions, and emotional exhaustion on safety climate. Results: The findings reveal that effective management leadership plays a pivotal role in shaping safety attitudes and fostering a robust patient safety culture. The study identifies three critical facets of patient safety that are entirely mediated by management perceptions: teamwork climate, working conditions, and stress recognition. The results highlight the importance of enhancing these dimensions to advance the patient safety culture within healthcare organizations. Moreover, stress recognition is identified as a critical factor influencing the organizational culture of patient safety. Conclusion: This research offers valuable insights for healthcare organizations seeking to prioritize patient safety and improve overall quality of care. By enhancing our understanding of the critical factors that shape safety attitudes and patient safety culture, this study provides a roadmap for effective management leadership and a culture of patient safety within healthcare organizations. The study underscores the significance of management leadership in promoting patient safety culture and highlights the importance of enhancing teamwork climate, working conditions, and stress recognition to advance patient safety culture.

Monochorionic-triamniotic triplet pregnancy following artificial reproductive technology: Report of a rare case in Taiwan.

OBJECTIVE: Monochorionic-triamniotic (MCTA) triplet pregnancies following artificial reproductive technologies are uncommon. We report a case in which one of two transferred embryos differentiated into an MCTA triplet. This study aimed to investigate the potential factors contributing to MCTA triplet pregnancy. CASE REPORT: A 39-year-old woman underwent her second frozen embryo transfer with hatching blastocysts, which resulted in the detection of an MCTA triplet on ultrasonography. She delivered by cesarean section at 32 weeks of gestation, resulting in the birth of three live male infants. Her medical history and in vitro fertilization treatment were reviewed to identify potential causes. CONCLUSION: The etiology of MCTA triplet pregnancy remains multifactorial. In the presented case, prolonged in vitro culture to the blastocyst stage and inner cell mass splitting were potential contributing factors. Further research is needed to fully understand the complexity of MCTA triplet pregnancy.

Caregivers' Burden on Patients with Dementia Having Multiple Chronic Diseases.

Purpose: This study aimed to find the caregiving burden level for patients with dementia who had multiple chronic diseases by simultaneously considering both patient and caregiver factors. Participants and Methods: A cross-sectional study with 284 patients with dementia having multiple chronic diseases managed by the dementia collaborative care team at Changhua Christian Hospital in Taiwan was conducted. The input variables were from patients, such as age, gender, mood symptoms, and behavioral and psychological symptoms, and caregivers, including age, relation to the patient, caregiver's mood, and caregiving burden. The Apriori algorithm was employed to determine the association between patient and caregiver factors and different caregiving burden levels by setting up the minimum support of 1% and confidence of 90% along with lift >1. Results: When caring for patients with dementia, twenty scenarios were found for caregivers with a severe burden. In addition, 1936 scenarios were related to caregivers with a moderate-to-severe burden. Specifically, there were eight scenarios for patients with three chronic diseases which could be further categorized into five general rules. Two hundred and fifty scenarios belonging to patients with two chronic diseases could be classified into 16 different combinations from eight chronic diseases of the database. Conclusion: Caregiver's mood, patients with mild dementia, and patients aged 75-84 years were associated with a severe caregiving burden. College and above education of the caregiver, the patient aged 85 years or more, and at least one of caregiver's moods were the variables to result in a moderate-to-severe burden for caregivers caring for patients with three multiple chronic diseases. Moreover, college and above education of the caregiver, mood symptom, age of the caregiver, and age of the patient were important variables for caregivers who had a moderate-to-severe burden taking care of patients with two chronic diseases.

Medical staff's emotional exhaustion and its relationship with patient safety dimensions.

PURPOSE: Medical staff's emotional exhaustion increases cynical attitudes and behaviors about work and patients and leads medical staff to become detached from work. This may decrease patients' trust and satisfaction and even endanger patients' lives. There is a need to examine the critical factors affecting the medical staff's emotional exhaustion by investigating its relationship with the patient-safety dimensions based on the safety attitudes questionnaire (SAQ). DESIGN/METHODOLOGY/APPROACH: A case study is conducted from the viewpoints of physicians and nurses to examine the relationship between emotional exhaustion and six dimensions of the SAQ from 2016 to 2020 from a regional teaching hospital in Taiwan. Linear regression with forward selection is employed. Six dimensions of the SAQ are the independent variables, whereas emotional exhaustion is the dependent variable for each year. FINDINGS: Stress recognition is the most important variable to influence emotional exhaustion negatively, while job satisfaction is the second important variable to affect emotional exhaustion positively from 2016 to 2020. On the contrary, working conditions do not influence emotional exhaustion in this hospital from medical staff's viewpoints. ORIGINALITY/VALUE: This study uses longitudinal data to find that both stress recognition and job satisfaction consistently influence emotional exhaustion negatively and positively, respectively, in this five-year period. The third dimension to impact emotional exhaustion varies from time to time. Thus, the findings from a cross-sectional study might be limited. The authors' findings show that reducing stress recognition and enhancing job satisfaction can lead to the improvement of emotional exhaustion from medical staff's viewpoints, which should be monitored by hospital management.

A comparative study on patient safety culture among high-risk hospital staff in the context of the COVID-19 and non-COVID-19 pandemic: a cross-sectional study in Taiwan.

The study aimed to compare the evolution of patient safety culture perceived by high-risk hospital staff in the context of the COVID-19 pandemic and non-COVID-19 pandemic and to examine the variations in patient safety culture across demographic variables. The study found that the COVID-19 pandemic has significantly impacted patient safety culture in healthcare settings, with an increased focus on safety climate, job satisfaction, teamwork climate, stress recognition, and emotional exhaustion. Safety culture and work stress vary among medical professionals of different age groups. To reduce stress, workload should be minimized, work efficiency improved, and physical and mental health promoted. Strengthening safety culture can reduce work-related stress, improve job satisfaction, and increase dedication towards work. The study recommends interventions such as psychological and social support, along with emotional management training, to reduce emotional exhaustion. Healthcare institutions can set up psychological counseling hotlines or support groups to help medical professionals reduce stress and emotional burden.

Care Need Combinations for Dementia Patients with Multiple Chronic Diseases.

Purpose: The purpose of this study was to find care need combinations for dementia patients with multiple chronic diseases and their caregivers. Patients and Methods: A cross-sectional study was conducted with 83 patients who had multiple chronic diseases. Variables from patients included age, gender, severity of clinical dementia rating, feeding, hypnotics, mobility, getting lost, mood symptoms, and behavioral and psychological symptoms. Moreover, 26 types of care needs were included in this study. The Apriori algorithm was employed to first identify care need combinations and then to find the relationships between care needs and variables from dementia patients with multiple chronic diseases. Results: Six rules were generated for care need combinations. Four care needs could be formed as a basic care need bundle. Moreover, two additional care needs could be added to provide a wider coverage for patients. In the second stage, 93 rules were found and categorized into three groups, including 2, 6, and 28 general rules with support of 30% but less than 40%, 20% but less than 30%, and 10% but less than 20%, respectively. When the support value is 10% but less than 20%, more variables from patients were found in rules which help the dementia collaborative care team members provide tailor-made care need bundles. Conclusion: Four basic care needs were social resources referral and legal support (Care (1)), drug knowledge education (Care (3)), memory problem care (Care (5)), and fall prevention (Care (8)). Besides, disease knowledge education (Care (2)) and hypertension care (Care (16)) were frequent unmet needs in this specific population. Moreover, care for the mood of the caregiver (Care (11)) should be considered especially in dementia patients with preserved ambulatory function or with symptoms of hallucination. The collaborative care team should pay more attention to those care needs when assessing this specific population.

Amniotic fluid embolism: A case report of good outcome with timely intensive multidisciplinary team involvement.

OBJECTIVE: Amniotic fluid embolism is one of the most serious pregnancy complications. It can cause sudden maternal collapse with high mortality and morbidity. We present a case report regarding the important of prompt decision making and multidisciplinary team work for management of amniotic fluid embolism to yield favorable maternal and neonatal outcome. CASE REPORT: This is a 35-year-old, gravida 2, para 1, woman underwent labor induction at gestational age of 37 + 6 weeks due to elective induction. She had sudden facial cyanosis and shortness of breath right after artificial rupture of membrane. Prompt decision of urgent cesarean section, aggressive and timely massive blood transfusion and multidisciplinary team work had spared patient from extracorporeal membrane oxygenation placement and prolonged hospitalization. A male infant was born with Apgar score 3' -> 5' with estimate body weight of 2958 gm; he was hospitalized for 10 days and no other complications was found at follow up pediatric outpatient clinic. CONCLUSION: One of the most dreadful, but rare pregnancy complications is amniotic fluid embolism (AFE). It can cause serious maternal and neonatal morbidity and mortality. Rapid recognition and multidisciplinary team management are essential to maternal and neonatal prognosis.

Evaluating the psychometric properties of the Chinese version of the Safety Attitudes Questionnaire among medical staff in Taiwan.

PURPOSE: The rapid changes that the healthcare services industry is undergoing pose a challenge to obtaining accurate measurements of the delivery of medical services to patients. Current Chinese measures of patient safety culture may not adequately capture how medical staff perceives the promotion of patient safety. This study aims to construct a valid and applicable patient safety culture instrument by re-estimating the Chinese version of the Safety Attitudes Questionnaire (SAQ) with medical staff in Taiwan. DESIGN/METHODOLOGY/APPROACH: Exploratory factor analysis (EFA) was conducted on data collected from a sample of 448 medical workers at a regional teaching hospital in Taiwan, and data from 804 participants at a medical center were subjected to confirmatory factor analysis (CFA). The distribution of the questions among the dimensions was different from that in the Chinese version of the SAQ. FINDINGS: The authors' results confirm that 3 correlated first-order factors, including 11 items, can be used to measure collaboration and safety, stress recognition and emotional exhaustion (EE). The authors' data suggest that the cooperation mechanism, patient safety promotion, stress management and emotional management are drivers of patient safety and should be prioritized when seeking to evaluate the perceptions of hospital staff toward patient safety culture in hospitals in Taiwan. ORIGINALITY/VALUE: To improve the quality and safety of patient care, the measurement scale should be revisited and modified as the industry changes over time and to take account of cultural variation. The authors restructured the current Chinese version of the SAQ developed by the Joint Commission of Taiwan (JCT) to offer more precise measures that increase the sensitivity of the measurement of the level of care in items of patient safety and that serve as a diagnostic instrument to review patient safety management.

Novel Inflammasome-Based Risk Score for Predicting Survival and Efficacy to Immunotherapy in Early-Stage Non-Small Cell Lung Cancer.

Immune checkpoint inhibitors (ICI) for early-stage non-small cell lung cancer (NSCLC) have been approved to improve outcomes and reduce recurrence. Biomarkers for patient selection are needed. In this paper, we proposed an inflammasome-based risk score (IRS) system for prognosis and prediction of ICI response for early-stage NSCLC. Cox regression analysis was used to identify significant genes (from 141 core inflammasome genes) for overall survival (OS) in a microarray discovery cohort (n = 467). IRS was established and independently validated by other datasets (n = 1320). We evaluated the inflammasome signaling steps based on five gene sets, which were IL1B-, CASP-1-, IL18-, GSDMD-, and inflammasome-regulated genes. Gene set enrichment analysis, the Kaplan-Meier curve, receiver operator characteristic with area under curve (AUC) analysis, and advanced bioinformatic tools were used to confirm the ability of IRS in prognosis and classification of patients into ICI responders and non-responders. A 30-gene IRS was developed, and it indicated good risk stratification at 10-year OS (AUC = 0.726). Patients were stratified into high- and low-risk groups based on optimal cutoff points, and high-risk IRS had significantly poorer OS and relapse-free survival. In addition, the high-risk group was characterized by an inflamed immunophenotype and higher proportion of ICI responders. Furthermore, expression of SLAMF8 was the key gene in IRS and indicated good correlation with biomarkers associated with immunotherapy. It could serve as a therapeutic target in the clinical setting of immunotherapy.

Applying Apriori algorithm to explore long-term care services usage status-Variables based on the combination of patients with dementia and their caregivers.

Purpose: The aim of this study was to identify the combination of patients with dementia and their caregivers' characteristics associated with long-term care (LTC) services usage. Patients and methods: A cross-sectional study was conducted with 475 patients with mild, moderate, and severe dementia at Changhua Christian Hospital, Taiwan. Eleven types of variables from patients with dementia, nine types of variables from patients' caregivers, and 15 types of LTC services were used for this study. The Apriori algorithm was employed to identify the attributes from the patients and their caregivers who used a particular LTC service from a comprehensive viewpoint. Results: A total of 75 rules were generated by the Apriori algorithm with support of 2%, confidence of 80%, and lift >1. Among these rules, 25 rules belonged to home personal care services which were summarized further into four general rules for home personal care services. On the other hand, 50 rules belonged to assistive devices that were summarized further into 21 general rules based on their similarities. Patient's walking ability, patient's emotional liability, unemployed or retired caregivers, caregivers' feelings with either helplessness or hopelessness, and caregivers who cared for patients with dementia solely were found to be the critical variables to use home personal care services. In contrast, patient's walking ability, age, and severity as well as caregivers' age, mood, marital status, caregiving burden, and the patient being cared for mainly by a foreign care helper were found to be the critical variables to use assistive devices. Conclusion: This study showed preliminary results on the LTC service usage from patients with dementia and their caregivers residing in the community. Understanding the patient-caregiver dyad's profile leads the service providers, policymakers, and the referral team to tailor service provisions better to meet the needs and identify the potential target groups. The findings in this study serve as references to reduce caregivers' burden as well as to improve the quality of care for patients with dementia.

Rare live birth to a 48-year-old woman after embryo transfer with autologous oocyte: A case report.

OBJECTIVE: Advanced maternal age and decreased ovarian reserve have been challenges for assisted reproductive technology (ART). Few cases, using autologous oocytes more than 46-years-old, have previously been reported. We seek to show how the age at which autologous oocytes may successfully be employed may be increasing. CASE REPORT: We report a 47-year-old woman with an anti-Müllerian hormone (AMH) level of 0.24 ng/mL, conceived through in vitro fertilization (IVF) using autologous oocytes. Patient was given an antagonist protocol for ovarian stimulation and one frozen-thawed embryo was transferred. The patient became pregnant. The course of her pregnancy was uneventful and she gave birth to a 3330 gm male baby by cesarean section. CONCLUSION: Technological advances permit women, who previously would have been considered too old to employ an autologous oocyte, to have a successful pregnancy with a live birth.